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Submitted on September 27, 2004
Accepted on March 15, 2005
Division of Adolescent Medicine (Drs. Golden, Iglesias, Jacobson, Shenker, Janet Schebendach and Wendy Meyer); Division of Pediatric Endocrinology (Dr. Carey) and Division of Child Psychiatry (Dr. Hertz), Schneider Children's Hospital, New Hyde Park, New York. North Shore-Long Island Jewish Health System, Albert Einstein College of Medicine
* To whom correspondence should be addressed. E-mail: golden{at}lij.edu.
Osteopenia is a serious medical complication of anorexia nervosa with no known effective treatment. We conducted a double-blinded randomized trial comparing alendronate 10 mg daily with placebo in 32 adolescents with anorexia nervosa, mean age 16.9 ± 1.9 yr. All subjects received 1200 mg of elemental calcium and 400 IU Vitamin D a day and received the same multidisciplinary treatment for their eating disorder. Bone mineral density (BMD) of the lumbar spine and femoral neck were measured by dual energy x-ray absorptiometry at baseline and after 1 yr of treatment. 29 subjects completed the study.
Femoral neck and lumbar spine BMD increased 4.4 ± 6.4% and 3.5 ± 4.6%, in the alendronate group compared with increases of 2.3 ± 6.9% and 2.2 + 6.1% in the control group (P = 0.41 femoral neck; P = 0.53 lumbar spine). From baseline to follow-up, BMD increased significantly at the femoral neck (P = 0.02) and lumbar spine (P = 0.02) in those receiving alendronate but did not do so in those assigned placebo (P = 0.22 femoral neck, P = 0.18 lumbar spine). At follow-up, body weight was the most important determinant of BMD. BMD was significantly higher in those who were weight restored compared with those who remained at low weight (P = 0.002 femoral neck, P = 0.04 lumbar spine). After controlling for body weight, treatment group assignment still had an independent effect at the femoral neck.
We conclude that in adolescents with anorexia nervosa, weight restoration is the most important determinant of BMD but treatment with alendronate did increase BMD of the lumbar spine and femoral neck within the group receiving alendronate but not compared with placebo in the primary analysis. Until further studies have demonstrated efficacy and long-term safety, the use of alendronate in this population should be confined to controlled clinical trials.
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